Healthcare Provider Details

I. General information

NPI: 1467349274
Provider Name (Legal Business Name): TAYLOR NICOLE BLANSETT PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 E HIGHLAND DR STE B
JONESBORO AR
72401-6491
US

IV. Provider business mailing address

PO BOX 11064
FAYETTEVILLE AR
72703-1001
US

V. Phone/Fax

Practice location:
  • Phone: 870-520-5014
  • Fax: 870-520-5015
Mailing address:
  • Phone: 870-520-5014
  • Fax: 870-520-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: